Private and corporate hospitals in the city have charged as much as Rs 12 crore in excess from the Central Government Health Scheme (CGHS) in the past 17 months by submitting inflated bills, the Central Vigilance Commission (CVC) stated in its recent report.
The hospitals had claimed Rs 43 crore as against the actual expenditure of Rs 31 crore incurred by them. Implemented by the Union health ministry, CGHS provides health care facilities for central government employees, pensioners and their dependents.
An official of CGHS, Hyderabad division, informed TOI that the CVC's report had stated that 14 hospitals claimed excess amount for providing treatment to patients. In all, 34 hospitals are empanelled for CGHS patients in Hyderabad.
Hospitals enter into an agreement with the CGHS, which has a special tariff for treatment including the charges of various wards, depending upon the eligibility of the card holder. Scrutiny of the bills revealed that the provision of agreement was not adhered to by the hospitals. For instance, room charges for private ward is Rs 750 per day for a BHEL employee and Rs 400 for BSNL employee, but these hospitals billed an amount of Rs 1500 even for these CGHS patients. It was also found that the hospitals did not submit monthly and annual reports to the health ministry on the number of CGHS patients who utilised the facility as per the agreement. Hospitals also violated agreement by not giving two per cent discount on payments made within seven days from the date of submission of bill and five per cent on every cash payment made immediately.
Sources said the CVC conducted the inquiry following a complaint made by a patient, who had undergone surgery in a corporate hospital last year. He had complained to the ministry of health and family welfare about the alleged irregularities in reimbursement of medical bills of the empanelled hospitals.
The official said that based on the CVC report, notices were sent to the hospitals last month seeking their explanation. Middle-level hospitals replied to the notices which were forwarded to Union health ministry but the bigger corporate hospitals are yet to submit their replies. As per rules, the Union health ministry is empowered to cancel the empanellment if the charges are proved, official sources said. Computerisation of processing of bills and claims to avoid such irregularities in future is also being contemplated, sources added.
Source: Times of India